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THE MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM FORM 2 PERFORMANCE INDICATORS AND SYSTEMS OUTCOMES TOOLKIT

AUGUST 2016; UPDATED NOVEMBER 2017

Technical Assistance Resource

Design Options for Home Visiting Evaluation

Form 2 Performance Indicators and Systems Outcomes Toolkit ii November 2017

The Maternal, Infant, and Early Childhood Home Visiting Program Form 2 Performance Indicators and Systems Outcomes Toolkit November 2017

Susan Zaid and Matthew Poes, James Bell Associates

About DOHVE

The purpose of the Design Options for Home Visiting Evaluation (DOHVE) contract is to provide research and evaluation support to the Maternal, Infant, and Early Childhood Home Visiting Program.

This document was prepared for the Health Resources and Services Administration and the Administration for Children and Families (ACF), U.S. Department of Health and Human Services, by James Bell Associates under ACF contract numbers HHSP23320095644WC and HHSP233201500133I. For additional DOHVE resources, visit http://www.jbassoc.com/reports-publications/dohve

Contact Information

For more information, contact the ACF Federal Project Officer or a member of the DOHVE team.

Nicole Denmark, Ph.D. Federal Project Officer Office of Planning, Research and Evaluation Administration for Children and Families U.S. Department of Health and Human Services [email protected] http://www.acf.hhs.gov/programs/opre

Susan Zaid, M.A. Jill Filene, M.P.H. DOHVE TA Deputy Project Director DOHVE TA Project Director James Bell Associates James Bell Associates 3033 Wilson Boulevard, Ste. 650 3033 Wilson Boulevard, Ste. 650 Arlington, VA 22201 Arlington, VA 22201 [email protected] [email protected] http://www.jbassoc.com/ http://www.jbassoc.com/

Suggested Citation

Zaid, S., & Poes, M. (2017). The Maternal, Infant, and Early Childhood Home Visiting Program: Form 2 performance indicators and systems outcomes toolkit. Arlington, VA: James Bell Associates.

Disclaimer

The views expressed in this publication do not necessarily reflect the views or policies of the Office of Planning, Research and Evaluation; the Administration for Children and Families; the Health Resources and Services Administration; or the U.S. Department of Health and Human Services.

http://www.jbassoc.com/reports-publications/dohve

mailto:[email protected]

http://www.acf.hhs.gov/programs/opre



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Form 2 Performance Indicators and Systems Outcomes Toolkit iii November 2017

Contents

Form 2 Performance Indicators and Systems Outcomes ......................................................... 1

2016 Redesign of the Performance Measurement System .......................................................................... 1

Annual Performance Reporting .................................................................................................................... 2

About the Toolkit .......................................................................................................................................... 3

Key Terms ...................................................................................................................................................... 3

Measure 1: Preterm Birth ...................................................................................................... 5

Measure 1: HRSA Data Collection Form ....................................................................................................... 5

Measure 1: Details ........................................................................................................................................ 5

Measure 1: Logic Statements for Data Inclusion in Reporting ..................................................................... 6

Measure 2: Breastfeeding ...................................................................................................... 8

Measure 2: HRSA Data Collection Form ....................................................................................................... 8

Measure 2: Details ........................................................................................................................................ 8

Measure 2: Logic Statements for Data Inclusion in Reporting ..................................................................... 9

Measure 3: Depression Screening ........................................................................................ 11

Measure 3: HRSA Data Collection Form ..................................................................................................... 11

Measure 3: Details ...................................................................................................................................... 11

Measure 3: Logic Statements for Data Inclusion in Reporting ................................................................... 12

Measure 4: Well-Child Visit .................................................................................................. 14


Measure 4: Details ...................................................................................................................................... 14


Measure 5: Postpartum Care ............................................................................................... 18


Measure 5: Details ...................................................................................................................................... 18


Measure 6: Tobacco Cessation Referrals .............................................................................. 21



Measure 7: Safe Sleep ......................................................................................................... 24


Form 2 Performance Indicators and Systems Outcomes Toolkit iv November 2017

Measure 7: Details ...................................................................................................................................... 24


Measure 8: Child Injury ........................................................................................................ 27


Measure 8: Details ...................................................................................................................................... 27


Measure 9: Child Maltreatment ........................................................................................... 30


Measure 9: Details ...................................................................................................................................... 30


Measure 10: Parent-Child Interaction .................................................................................. 33

Measure 10: HRSA Data Collection Form ................................................................................................... 33

Measure 10: Details .................................................................................................................................... 33

Measure 10: Logic Statements for Data Inclusion in Reporting ................................................................. 34

Measure 11: Early Language and Literacy Activities .............................................................. 36


Measure 11: Details .................................................................................................................................... 36


Measure 12: Developmental Screening ................................................................................ 38


Measure 12: Details .................................................................................................................................... 38


Measure 13: Behavioral Concerns ........................................................................................ 41


Measure 13: Details .................................................................................................................................... 41


Measure 14: Intimate Partner Violence Screening ................................................................ 44


Measure 14: Details .................................................................................................................................... 44


Measure 15: Primary Caregiver Education ............................................................................ 47


Measure 15: Details .................................................................................................................................... 47

Form 2 Performance Indicators and Systems Outcomes Toolkit v November 2017


Measure 16: Continuity of Insurance Coverage .................................................................... 50


Measure 16: Details .................................................................................................................................... 50


Measure 17: Completed Depression Referrals ...................................................................... 52


Measure 17: Details .................................................................................................................................... 52


Measure 18: Completed Developmental Referrals ............................................................... 55


Measure 18: Details .................................................................................................................................... 55


Measure 19: Intimate Partner Violence Referrals ................................................................. 58


Measure 19: Details .................................................................................................................................... 58


Appendix A: Guidance on Reporting Index Children ............................................................. 61

Appendix B: Guidance on Identifying Missing Data .............................................................. 64

Appendix C: Content Area Alignment for the MIECHV Program’s Performance Measures ..... 70

The Maternal, Infant, and Early Childhood Home Visiting Program Form 2 Performance Indicators and Systems Outcomes Toolkit

2016 Redesign of the Performance Measurement System

Awardees funded under the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) must collect and report data on program implementation and performance for eligible families participating in the program in the legislatively mandated benchmark areas of: (1) improvements in maternal, newborn, and child health; (2) prevention of child injuries, child abuse, neglect, or maltreatment, as well as reductions of emergency room visits; (3) improvements in school readiness and child academic achievement; (4) reductions in crime or domestic violence; (5) improvements in family economic self-sufficiency; and (6) improvements in the coordination and referrals for other community resources and supports. MIECHV is administered by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau in collaboration with the Administration for Children and Families (ACF).

In 2016, HRSA revised the existing performance measurement system for the MIECHV Program. The purpose was to simplify, standardize, and strengthen the reported performance measures. The redesigned performance measurement system builds on the PEW1 Home Visiting Project and was developed with input from MIECHV awardees, federal partners, representatives of home visiting model developers, content experts, and technical assistance (TA) providers through listening sessions held from January through April 2015 and a public comment period from September through October 2015. The revised measures better align with other U.S. Department of Health and Human Services (HHS) performance metrics. The Office of Management and Budget (OMB) approved the revised performance measures in March 2016. Awardees began implementing the revised measures in October 2016.

The performance measures include two types of data: Form 1 – Demographic, Service Utilization, and Select Clinical Indicators. These data summarize program participant demographics and characteristics of service utilization at the state level. Major revisions include the addition of variables related to the usual source of medical and dental care for index children, housing status, and participation by an evidence-based home visiting model. The revised form also streamlines reporting and reduces the burden for awardees by removing multi-variable tables (e.g., marital status by race).

Form 2 – Performance Indicators and Systems Outcome Measures. This form requires data to be submitted on eligible populations for select indicators that represent the six statutorily defined benchmark areas. There is an overall reduction in total measures from 37 to 19 in the revised system. Measures are standardized to better allow for aggregation and summarization at the national level. HRSA has included two types of measures in Form 2 – performance indicators and systems outcome measures.

1 http://www.pewtrusts.org/en/research-and-analysis/reports/2015/10/using-data-to-measure-performance-of-home-visiting

http://www.pewtrusts.org/en/research-and-analysis/reports/2015/10/using-data-to-measure-performance-of-home-visiting

http://www.pewtrusts.org/en/research-and-analysis/reports/2015/10/using-data-to-measure-performance-of-home-visiting

Form 2 Performance Indicators and Systems Outcomes Toolkit 2 November 2017

Performance indicators are proximal to the home visiting intervention and have been shown through previous research to be sensitive to change through home visiting alone. Performance indicators will be used to describe and monitor the performance of awardees; to target technical assistance resources in areas where there are opportunities for performance improvement; and to assist in developing required continuous quality improvement (CQI) and technical assistance plans. In future years, they may be used to demonstrate program performance accountability. Performance on these indicators may be used as one determinant in future funding formulas, which will reward high performing awardees.

Systems outcome measures are more distal to the intervention and/or do not have as strong evidence to support the effect of home visiting alone on the outcome due to many factors, including confounding influences or differences in available system infrastructure at the state or community level. Systems outcome measures will be used to describe and monitor systems-level change at the state level (not solely attributed to home visiting interventions); target technical assistance to state-level systems building and coordination efforts of awardees; and compare the outcomes of service populations with comparable populations using available state or nationally representative data sources.

Major revisions to Form 2 are described in the table below.

Table 1. Revisions to Form 2

Added new constructs

Preterm Birth, Postpartum Care, Safe Sleep, Behavioral Concerns, Continuity of Insurance, Completed Depression and Developmental Referrals

Revised existing constructs

Breastfeeding, Depression Screening, Tobacco Use, Well-Child Visits, Child Emergency Department Visits, Educational Attainment

Removed constructs

Prenatal Care, Preconception Care, Inter-Birth Interval, Maternal Emergency Department Visits, Suspected Maltreatment, Parent Emotional Well-Being, Intimate Partner Violence (IPV) Safety Plan, Arrests, Convictions, Income

Annual Performance Reporting Awardees submitted benchmark Performance Measurement Plans (PMP) and made necessary updates and revisions to data systems in order to begin data collection on October 1, 2016. The first data collection period for the new measures was October 1, 2016, through September 30, 2017. Awardees began reporting the new measures to HRSA in October 2017. HRSA encourages awardees to work with their home visiting model developers and technical assistance providers while revising their data systems, providing training on data collection to local implementing agencies, and supporting local implementing agencies in new data collection procedures. In addition, awardees should work with their HSRA Project Officer to make any necessary changes to their Form 2 PMP, as needed. A change request should be submitted to HRSA for any change to a PMP, and all changes must be reviewed and approved by HRSA before being implemented by an awardee.


About the Toolkit The purpose of this document is to support awardees in reporting quality, consistent, and accurate data for each of the standardized measures in Form 2. This document

supplies guidance on how to collect and report performance measures;

includes awardee-populated fields to specify data sources, data collection plans, and modifications to existing processes to address new measures; and

eliminates the need for an additional benchmark and data plan. Each performance measure includes four sections.

1. HRSA Data Collection Form. This is the data collection form as it appears in the Home Visiting Information System (HVIS). Data will be submitted on each measure in a table similar to what is presented on the data collection form. The HRSA data collection form for each measure is included in this document so awardees may identify what information will be submitted during each annual report.

2. Measure Details. This section provides additional information to help operationalize each measure, including details related to the target population, data collection time points, data elements, validated tools, missing data, and additional considerations related to the measure. Details about the measure provided in this section may be helpful as awardees develop or modify data collection forms and data systems for the new measures.

3. Sample Data Collection Elements. This section includes sample data elements collected for each measure along with sample calculations. This section is provided as an example to awardees of possible data elements that need to be available in order to calculate the data value for each measure.

4. Logic Statements for Data Inclusion in Reporting. This section is intended to aid awardees in reporting data that meet the inclusion criteria for each measure. The section includes a series of logic statements to help identify the parameters for data inclusion in each reporting period. The logic statements align with the measure definition.

Key Terms Target population. For the purposes of performance measurement reporting, the MIECHV Program service population is the one being assessed by the measure. For example, the target population for the maternal depression screening measure is all primary caregivers enrolled in MIECHV services for at least 3 months; the target population for the child injury measure is all index children enrolled in MIECHV services. The target population assessed for each measure determines which participants are eligible to be included in the numerator and denominator. The target population for each measure is included in the Measure Details section.

Data collection time points. This refers to the points in time during the reporting period or a family’s time in service in which data elements need to be collected to be accurately reported for the measure. For example, a program may require primary caregivers to be screened for IPV within 1 month of enrollment and annually thereafter. The program will need to consider whether these data collection time points align with HRSA’s measure definitions or if additional data collection time points need to be added to meet the reporting requirements.

Data elements. Data elements reflect the types of responses that are being documented in the forms or data systems. Data elements are identified as needed for the calculation of a measure. Collection


forms are intended to gather the necessary elements, and the data systems will then provide the appropriate variables for reporting. For example, in order to assess if primary caregivers were screened for IPV within 6 months of enrollment, awardees will need to identify the number of primary caregivers who have been enrolled for at least 6 months during that reporting year and whether an IPV screening was administered to the caregiver during that time. Necessary data elements may include identification of primary caregiver, date of enrollment, and date of IPV screening. If awardees only collect data on whether an IPV screening was administered (yes/no) without the date of the IPV screening, then they will be unable to assess whether the screening was completed within the 6-month window.

Numerator. In a fraction, the numerator is the top value. For the performance measures, the numerator reflects the portion/number of the population defined in the denominator for which the specified event is true. For example, if the fraction represents the proportion of primary caregivers enrolled in home visiting who received an IPV screening, then the numerator is the number of caregivers who received the screening. For proportions and percentages, the numerator should be a subset of the denominator and will never be larger than the denominator. For rates, the numerator is not a subset of the denominator. In the revised performance measurement system, Measure 9: Child Injuries is the only measure reported as a rate; the rest of the measures are reported as percentages.

Denominator. In a fraction, the denominator is the bottom value. For the performance measures, the

denominator reflects the size/number of the population being assessed. In the example with the fraction representing the proportion of primary caregivers enrolled in home visiting who received an IPV screening, then the denominator is the number of primary caregivers who were enrolled.

Validated tool. A validated tool is an instrument that has been psychometrically tested for reliability, validity, sensitivity, and specificity. A reliable tool is both consistent and stable at measuring a construct. A valid tool measures the concept it was intended to measure. Sensitivity represents the degree to which an instrument correctly identifies those individuals who have a specific condition. Specificity is the degree to which an instrument correctly screens out those individuals who do not have a specific condition. Some measurement tools have training requirements that need to be met before staff can administer the tool. HRSA requires awardees to use a validated tool for four measures – Measure 3: Depression Screening, Measure 10: Parent-Child Interaction, Measure 12: Developmental Screening, and Measure 14: Intimate Partner Violence Screening.


Measure 1: Preterm Birth

Measure 1: HRSA Data Collection Form

The HRSA data collection form below identifies the measure definition and what information will be submitted during each annual report. Awardees will enter the numerator and denominator values in HVIS. Missing data, along with any information that may help explain the data, should be reported in the notes.

1. BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH

CONSTRUCT: Preterm Birth

2. TYPE OF MEASURE

Systems Outcome

3. PERFORMANCE MEASURE

Percent of infants (among mothers who enrolled in home visiting prenatally before 37 weeks) who are born preterm following program enrollment

4. SPECIFICATION

NUMERATOR: Number of live births (index child or subsequent children among mothers who enrolled in home visiting prenatally before 37 weeks) born before 37 completed weeks of gestation and after enrollment

DENOMINATOR: Number of live births after enrollment who were born to mothers enrolled in home visiting prenatally before 37 weeks

5. VALUE FOR REPORTING PERIOD

Value: (percentage)

Numerator:

Denominator:

6. NOTES

*Columns highlighted in blue are data values entered by awardees in HVIS.

Measure 1: Details

Target Population: Pregnant women enrolled prior to 37 completed weeks of gestation and who delivered in the reporting period. Data Collection Time Point: End of pregnancy. Frequency of Reporting: This measure is assessed for each pregnancy while enrolled in the program. Eligible pregnant women and pregnancies may therefore be included in more than one annual report. Suggested Data Elements: Date of enrollment, gestational age at enrollment (or estimated delivery date to calculate gestational age at enrollment), child date of birth, live birth status (yes/no). Validated Tool: NA Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. Missing data should not be included in the measure calculation.


Additional Notes:

To be included in the reporting period, participants need to have enrolled prior to 37 completed weeks of gestation and delivered the baby during the reporting period. If the participant enrolls prior to 37 weeks in the current reporting period but delivers in the subsequent reporting period, the participant will be included in the subsequent reporting submission. If she enrolls prior to 37 weeks in the previous reporting period but delivers in the current reporting period, she will be included in the current report submission.

Preterm birth is defined as a birth before the 37 completed weeks of gestation (defined as up to 36 weeks and 6 days). The “37 completed weeks” means 36 weeks and 7 days. (Reference: http://www.who.int/mediacentre/factsheets/fs363/en/.)

Measure 1: Logic Statements for Data Inclusion in Reporting The logic statements provided below are intended to help awardees identify the parameters for data inclusion in each reporting period. The logic statements align with the measure definition.

Measure Definition: Percentage of infants born to mothers enrolled in home visiting prior to 37 completed weeks of gestation (preterm) and delivered in the reporting period. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the child enrolled in home visiting was born during the reporting period, (2) if the primary caregiver enrolled prior to 37 completed weeks of gestation, and (3) the gestational age at the time of birth. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each child enrolled in your program at any point during the reporting period, was s/he

born during the reporting period?

Yes – Continue to next

question.

No – This child is not included

in the numerator or

denominator and is not

counted as missing.

Information missing – Include

in missing cases for this

measure.

2. Did the primary caregiver enroll prenatally prior to 37 completed weeks of gestation?


question.

No – This child is not included

in the numerator or


counted as missing.



measure.

?

?

http://www.who.int/mediacentre/factsheets/fs363/en/


3. What was the gestational age at the time of birth?

Gestational age at birth

determined – Continue to next

question.

Gestational age at birth not

determined – Include in missing

cases for this measure.

4. Was the child born less than 37 completed weeks of gestation?

Yes – Include in numerator and

denominator for this measure.

No – Include in denominator

for this measure, but do not

include in numerator.



measure.

?

? / /


Measure 2: Breastfeeding




CONSTRUCT: Breastfeeding

2. TYPE OF MEASURE

Systems Outcome


Percent of infants (among mothers who enrolled in home visiting prenatally) who were breastfed any amount at 6 months of age

4. SPECIFICATION

NUMERATOR: Number of infants aged 6-12 months (index child among mothers who enrolled in home visiting prenatally) who were breastfed any amount at 6 months of age

DENOMINATOR: Number of infants aged 6-12 months (index child among mothers who enrolled in home visiting prenatally) enrolled in home visiting for at least 6 months


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 2: Details

Target Population: Index children who reached 6 to 12 months of age within the reporting period whose mothers enrolled prenatally and have been enrolled for at least 6 months. Data Collection Time Point: Home visit at or after the index child reached 6 months and before the child reaches 12 months. Frequency of Reporting: This measure is assessed in the reporting period for which the index children are between 6 and 12 months during the reporting period. Once an eligible index child has been included in the measure, s/he is excluded from subsequent reporting periods. Suggested Data Elements: Date of enrollment, child’s date of birth, breastfed any amount at 6 months, date assessed. Validated Tool: NA Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. Missing data should not be included in the measure calculation.


Additional Notes:

The measure captures if the index child received breastmilk in any amount at 6 months of age, not if the child was continuously or exclusively breastfed for 6 months.

Since the measure reflects whether the index child received breastmilk at 6 months of age, data collection should occur when the child is older than 6 months, but prior to 12 months.

This measure may be assessed retrospectively.

Medical exclusion criteria can be found at http://www.cdc.gov/breastfeeding/disease/.

Measure 2: Logic Statements for Data Inclusion in Reporting

The logic statements provided below are intended to help awardees identify the parameters for data inclusion in each reporting period. The logic statements align with the measure definition.

Measure Definition: Percentage of index children who were breastfed any amount at 6 months of age and whose mothers enrolled in home visiting prenatally. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the index child’s mother enrolled prenatally, (2) if the child’s age was between 6 and 12 months during the reporting period, (3) if the breastfeeding status was assessed, and (4) if the breastfeeding status was assessed when the child was between 6 and 12 months. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. Did the index child’s mother enroll in home visiting prenatally?


question.

No – This index child is not

included in the numerator or

denominator and is not counted as

missing.



measure.

2. Was the index child between 6 to 12 months of age during the reporting period?


question.

No – This index child is not included

in the numerator or denominator

and is not counted as missing.



measure.

?

?

http://www.cdc.gov/breastfeeding/disease/


3. Did the date of the breastfeeding assessment occur between the index child’s age of 6 and 12

months?


question.



denominator and is not counted as

missing.



measure.

4. Did the breastfeeding assessment indicate the index child received breastmilk in any amount

when s/he was 6 months of age?



No – Include in denominator for

this measure, but do not include in

numerator.



measure.

?

? / /


Measure 3: Depression Screening




CONSTRUCT: Depression Screening

2. TYPE OF MEASURE

Performance Indicator


Percent of primary caregivers enrolled in home visiting who are screened for depression using a validated tool within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for those enrolled prenatally)

4. SPECIFICATION

NUMERATOR: For those not enrolled prenatally, number of primary caregivers enrolled in home visiting who are screened for depression within the first 3 months since enrollment; for those enrolled prenatally, the number of primary caregivers screened for depression within 3 months of delivery

DENOMINATOR: For those not enrolled prenatally, the number of primary caregivers enrolled in home visiting for at least 3 months; for those enrolled prenatally, the number of primary caregivers enrolled in home visiting for at least 3 months post delivery


Value: (percentage)

Numerator:

Denominator:

6. NOTES

7. MEASUREMENT TOOL UTILIZED

Indicate the validated measurement tool(s) utilized to address this measure


Measure 3: Details

Target Population: Primary caregivers who have been enrolled for at least 3 months. Data Collection Time Point: At least 3 months after enrollment for those enrolled postnatally and at least 3 months post-delivery for those enrolled prenatally. Frequency of Reporting: This measure is assessed at one point in time per eligible family. Primary caregivers do not need to be reported again for subsequent pregnancies that occur after they are enrolled in home visiting. Suggested Data Elements: Date of enrollment, child’s date of birth, caregiver depression screening, date of screening, enrolled prenatally.


Validated Tool: Awardees must use a validated tool for this measure. Depression should be defined in accordance to the validated depression screening tool’s definition of depression. Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. When there is no documentation of whether the screening occurred using a validated tool, but all other data elements are known, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator. Additional Notes: This measure captures two target populations with different screening windows. Data from both target populations should be aggregated into one value for this measure.



Measure Definition: Percentage of primary caregivers enrolled in home visiting who were screened for depression using a validated tool within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for those enrolled prenatally). Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the primary caregiver enrolled postnatally and was enrolled for at least 3 months in the reporting period or if the primary caregiver enrolled prenatally and was enrolled for at least 3 months postpartum in the reporting period and (2) if the primary caregiver was screened for depression with a validated tool within 3 months of enrollment for those enrolled postnatally or within 3 months of delivery for those enrolled prenatally. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each primary caregiver enrolled in your program, did she enroll prenatally or postnatally?

Primary caregiver enrolled

prenatally – Continue to next

question.

Primary caregiver enrolled

postnatally – Continue to

question 4.



measure.

?


2. For each primary caregiver who enrolled prenatally, did she reach 3 months postpartum

during the reporting period?


question.

No – The primary caregiver is

not included in the numerator

or denominator and is not

counted as missing.



measure.

3. For each primary caregiver who enrolled prenatally, was she screened for depression with a

validated tool within 3 months postpartum?

Yes – Include in the numerator

and denominator for this

measure.

No – Include in the

denominator for this measure,

but do not include in the

numerator.

Screening information missing

– Include in the denominator

for this measure, but not in the

numerator.

4. For each primary caregiver who enrolled postnatally, was she enrolled for at least 3 months



question.

No – This primary caregiver is



counted as missing.



measure.

5. For each primary caregiver who enrolled postnatally, was she screened for depression using a

validated tool within 3 months of enrollment?






numerator.



for this measure, but not the

numerator.

?

/

?

/

/

/

/

/


Measure 4: Well-Child Visit




CONSTRUCT: Well Child Visit

2. TYPE OF MEASURE



Percent of children enrolled in home visiting who received the last recommended visit based on the American Academy of Pediatrics (AAP) schedule

4. SPECIFICATION

NUMERATOR: Number of children (index child) enrolled in home visiting who received the last recommended well child visit based on the AAP schedule DENOMINATOR: Number of children (index child) enrolled in home visiting


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 4: Details

Target Population: Enrolled index children. Data Collection Time Point: Data regarding well-child visits will be collected at multiple points in time throughout enrollment to correspond to the AAP recommendation schedule. Data may be collected after each scheduled well-child visit or retrospectively at the end of the reporting period Frequency of Reporting: This measure is assessed in multiple reporting years for all index children enrolled in the program. Eligible children may therefore be included in more than one annual report. Suggested Data Elements: Date of home visit, completion of last expected well-child visit. Validated Tool: N/A Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. Missing data should not be included in the measure calculation. This includes if the home visit occurred but the home visitor did not collect the data. If a home visit did not occur during the most recent age requiring a well-child visit, then data from the previous expected well-child visit should be reported.


Additional Notes:

All index children who received services for any length of time during the reporting period should be counted in that reporting period.

This measure does not assess if the index child is up to date on visits, but assesses if the last expected well-child visit was completed based on the child’s current age and the date it was collected.

Awardees should use the following intervals, which are based on the American Academy of Pediatrics (AAP) schedule (https://www.aap.org/en-us/Documents/periodicity_schedule.pdf) and depend on the child’s age: 3 to 7 days, 2 to 4 weeks, 2 to 3 months, 4 to 5 months, 6 to 7 months, 9 to 10 months, 12 to 13 months, 15 to 16 months, 18 to 19 months, 2 to 2.5 years, 3 to 3.5 years, and 4 to 4.5 years. These intervals allow for a window for the visits to occur. For instance, the 9-month visit could occur for the index child anytime between 9 to 10 months of age.



Measure Definition: Percentage of index children enrolled in home visiting who received the last recommended visit based on the AAP schedule. Inclusion Criteria: Expected well-child visit may be determined using a table of recommended well-child visits based on the AAP schedule. At the end of the reporting period, verify (1) when each index child’s last home visit occurred, (2) the child’s age at the date of the last home visit, (3) which AAP expected well-child visit should have occurred prior to the last home visit, and (4) if the expected AAP visit was completed. When determining which AAP expected well-child visit should have occurred prior to the last home visit, keep in mind each well-child visit has a window for completion. The window for data collection should end prior to the last home visit. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each index child enrolled in your program, was s/he actively enrolled in home visiting for

any part of the reporting period?


question.




counted as missing.



measure.

?

https://www.aap.org/en-us/Documents/periodicity_schedule.pdf


2. When was the last home visit with the family?

Date provided – Continue to next

question.

Date not provided – Include in missing


3. What was the index child’s age at the time of the last home visit with the family?

Index child’s age is known/can be

calculated – Continue to next question.

Unable to determine index child’s age –

Include in missing cases for this measure.

4. Prior to the last home visit with the family, what was the last expected well-child visit based

on AAP recommendations?

Index child’s age range during last

expected well-child visit is known/can be

calculated – Continue to next question.

Index child’s age range during last

expected well-child visit cannot be

determined – Include in missing cases for

this measure.

5. What was the index child’s age at her/his last reported well-child visit?

Index child’s age at last well-child visit is

known/can be calculated – Continue to

next question.

Index child’s age at last well-child visit

cannot be determined – Include in missing


?

?

?

?


6. Did the last reported well-child visit for the index child fall within the age range of the last

expected well-child visit?



No – Include in denominator for this

measure, but do not include in numerator.

/ /


Measure 5: Postpartum Care




CONSTRUCT: Postpartum Care

2. TYPE OF MEASURE



Percent of mothers enrolled in home visiting prenatally or within 30 days after delivery who received a postpartum visit within a healthcare provider within 8 weeks (56 days) of delivery

4. SPECIFICATION

NUMERATOR: Number of mothers enrolled in home visiting prenatally or within 30 days after delivery who received a postpartum visit with a healthcare provider within 8 weeks (56 days) of delivery DENOMINATOR: Number of mothers who enrolled in home visiting prenatally or within 30 days after delivery and remained enrolled for at least 8 weeks (56 days) after delivery


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 5: Details

Target Population: Mothers enrolled prenatally or within 30 days of giving birth and remain enrolled for at least 8 weeks after delivery. Data Collection Time Point: At least 56 days postdelivery. Frequency of Reporting: This measure is assessed at one point in time per eligible family. Primary caregivers do not need to be reported again for subsequent pregnancies that occur after they are enrolled in home visiting. Suggested Data Elements: Mother enrolled prenatally, date of enrollment, postpartum health visit, postpartum health visit date, length of enrollment, child date of birth. Validated Tool: N/A Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. Missing data should not be included in the measure calculation.


Additional Notes:

This measure captures two target populations. Data from both target populations should be aggregated into one value for this measure.

A postpartum visit is defined as a visit between the mother and her health care provider to assess her current physical health, including the status of pregnancy-related conditions like gestational diabetes, screen for postpartum depression, provide counseling on infant care and family planning as well as screening and referrals for the management of chronic conditions. Additionally, a provider may use this opportunity to conduct a breast exam and discuss breastfeeding.

The American College of Obstetricians and Gynecologists recommends that mothers receive a postpartum care visit 4 to 6 weeks after delivery. (Reference: Health Resources and Services Administration. Child Health USA 2013: Postpartum Visit and Well-Baby Care. Retrieved from http://mchb.hrsa.gov/chusa13/health-services-utilization/p/postpartum-visit-well-baby-care.html.)



Measure Definition: Percentage of mothers enrolled in home visiting prenatally or within 30 days after delivery who received a postpartum visit within 8 weeks (56 days) of delivery by a healthcare provider. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the mother enrolled in home visiting prenatally or within 30 days after delivery during the reporting period, (2) if the mother was 8 weeks (56 days) after delivery at any point in the reporting period, and (3) if a postpartum visit took place on or before 8 weeks (56 days) after delivery. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each mother enrolled in your program at any point during the reporting period, was she

enrolled prenatally or within 30 days after delivery?


question.

No – This mother is not



counted as missing.



measure.

?

http://mchb.hrsa.gov/chusa13/health-services-utilization/p/postpartum-visit-well-baby-care.html

http://mchb.hrsa.gov/chusa13/health-services-utilization/p/postpartum-visit-well-baby-care.html


2. Was the mother enrolled in your program for at least 8 weeks (56 days) after delivery within

the reporting period?


question.

No – This mother is not



counted as missing.



measure.

3. Did the mother complete a postpartum visit on or before 8 weeks (56 days) after delivery?






numerator.



measure.

?

? / /


Measure 6: Tobacco Cessation Referrals




CONSTRUCT: Tobacco Cessation Referrals

2. TYPE OF MEASURE



Percent of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment

4. SPECIFICATION

NUMERATOR: Number of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment DENOMINATOR: Number of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at enrollment and were enrolled for at least 3 months


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 6: Details

Target Population: Primary caregivers enrolled for 3 months who used tobacco or cigarettes at enrollment. Data Collection Time Point: Intake and 3 months post enrollment. Frequency of Reporting: This measure is assessed at one point in time per eligible family. Suggested Data Elements: Date of enrollment, tobacco use at enrollment, tobacco cessation referral, date of tobacco cessation referral. Validated Tool: N/A Missing Data: Missing data will affect accuracy and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. When there is no documentation of whether the primary caregiver received a referral for screening to indicate whether the caregiver used tobacco or cigarettes at enrollment, but all other data elements are known and inclusion in the denominator can be determined,


then the primary caregiver should be included in the denominator (if eligible), but not in the numerator. Additional Notes:

This measure requires all participants to be assessed for tobacco use at the time of enrollment, although only those who report tobacco use at the time of enrollment will be included in the measure.

If they were already receiving tobacco cessations services at enrollment, primary caregivers should be excluded from the denominator.

Home visiting models/programs should determine what constitutes an appropriate referral.

Tobacco includes combustibles (cigarettes, cigars, pipes, hookahs, and bidis), non-combustibles (chew, dip, snuff, snus, and dissolvables), and ENDS. Awardees must adhere to this definition of tobacco substances, which corresponds with the CDC definition (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6325a3.htm).



Measure Definition: Percentage of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the primary caregiver reported using tobacco or cigarettes at the time of enrollment and (2) if the primary caregiver received a referral to tobacco cessation counseling or services within 3 months of enrollment. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each primary caregiver enrolled in your program, did s/he report tobacco or cigarette use

at the time of enrollment?

Yes – Continue to next question.




counted as missing.

Information missing – Include in

missing cases for this measure.

?

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6325a3.htm


2. For each primary caregiver who indicated “yes” to tobacco use, was s/he already receiving

tobacco cessation services?

Yes – Exclude from the

numerator and denominator,

do not include in missing.

No – Continue to

next question.

3. Was the primary caregiver enrolled for at least 3 months during the reporting period?


question.




counted as missing.



measure.

4. Was the primary caregiver referred to tobacco cessation counseling or services within 3 months

of enrollment?






numerator.

?

/ /


Measure 7: Safe Sleep



1. BENCHMARK AREA: CHILD INJURIES, ABUSE, NEGLECT, AND MALTREATMENT AND EMERGENCY DEPARTMENT VISITS

CONSTRUCT: Safe Sleep

2. TYPE OF MEASURE



Percent of infants enrolled in home visiting that are always placed to sleep on their backs, without bed-sharing or soft bedding

4. SPECIFICATION

NUMERATOR: Number of infants (index child aged less than 1 year) enrolled in home visiting whose primary caregiver reports that they are always placed to sleep on their backs, without bed-sharing or soft bedding DENOMINATOR: Number of infants (index child) enrolled in home visiting who were aged less than 1 year during the reporting period


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 7: Details

Target Population: Index children less than 1 year of age during the reporting period. Data Collection Time Point: Within 1 year of date of birth. Frequency of Reporting: This measure may be assessed in multiple reporting years for all eligible index children enrolled in the program. Eligible children may therefore be included in more than one annual report. Suggested Data Elements: Child date of birth, safe sleep practices. Validated Tool: N/A Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. Missing data should not be included in the measure calculation.


Additional Notes:

Safe sleep practices should be measured using primary caregiver’s reported sleep practices during the index child’s first year and may be measured at various times throughout the year.

To assess the measure accurately, the primary caregiver should be asked specifically (1) if s/he always places the index child to sleep on her/his back and (2) if s/he always places the index child to sleep without bed-sharing or soft bedding. To be assessed as having safe sleep habits, the primary caregiver needs to answer “yes” to both parts of the measure.

Safe sleep practices may be assessed at multiple data collection points. If measured at multiple points in time during enrollment (such as by asking the primary caregiver during each visit), then the assessment completed in the home visit closest to the end of the reporting period should be used in the calculation.



Measure Definition: Percentage of index children less than 1 year of age enrolled in home visiting that are always placed to sleep on their backs, without bed-sharing or soft bedding. It is important to note in the second statement about bed-sharing and soft bedding, that neither bed-sharing nor soft bedding are considered safe sleep practices. It is not an “either or” statement. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the child enrolled in home visiting was exactly 1 year old or younger at any point during the reporting period, (2) if the primary caregiver was assessed for safe sleep practices at least once during the reporting period, and (3) if the primary caregiver responded affirmatively to all components of the measure. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each index child enrolled in your program, was s/he exactly 1 year old or younger at any

point in the reporting period?


question.




counted as missing.



measure.

?


2. Did the primary caregiver report that s/he always placed her/his index child to sleep on

her/his back and without bed-sharing or soft bedding?






numerator.

Information missing/safe sleep

assessment not completed –

Include in missing cases for this

measure.

? / /


Measure 8: Child Injury




CONSTRUCT: Child Injury

2. TYPE OF MEASURE

System Outcome


Rate of injury-related visits to the Emergency Department (ED) since enrollment among children enrolled in home visiting

4. SPECIFICATION

NUMERATOR: Number of parent-reported nonfatal injury-related visits to the ED since enrollment among children (index child) enrolled in home visiting

DENOMINATOR: Number of children (index child) enrolled in home visiting


Value: (rate)

Numerator:

Denominator:

6. NOTES


Measure 8: Details

Target Population: Enrolled index children. Data Collection Time Point: End of reporting period. Frequency of Reporting: This measure is assessed in multiple reporting years for all eligible index children enrolled in the program. Eligible children may therefore be included in more than one annual report. Suggested Data Elements: Emergency department visit, emergency department visit date. Validated Tool: N/A Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. Missing data should not be included in the measure calculation.


Additional Notes:

Index child emergency department visits should only be recorded if they occur during enrollment. Visits that occur during the reporting period but prior to enrollment should be excluded.

Injury-related emergency department visits are defined as injuries resulting from the following causes or mechanisms of injury: motor vehicle, suffocation, drowning, poisoning, fire/burns, falls, sports and recreation, and intentional injuries, such as child maltreatment. (Reference: Centers for Disease Control and Prevention. National Action Plan for Child Injury Prevention. 2012. Retrieved from https://www.cdc.gov/safechild/pdf/national_action_plan_for_child_injury_prevention.pdf.)

This measure is reported as a rate. The numerator represents the number of emergency department visits, not the number of children who visited the emergency department.

To ensure data are available by the end of the reporting period, the program may choose to assess the measure at multiple time points to ensure missed home visits do not prevent data collection. If the measure is assessed at multiple time points, the assessment closest to the end of the reporting period should be used.



Measure Definition: Rate of injury-related visits to the Emergency Department (ED) since enrollment for children enrolled in home visiting. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the index child was enrolled in home visiting for any length of time during the reporting period and (2) if the primary caregiver was assessed for nonfatal injury-related ED visits for the child during the reporting period. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each index child enrolled in your program, was s/he actively enrolled for any part of the

reporting period?

Yes – Continue to

next question.


included in the denominator,

no visits are included in the

numerator, and the case is not

counted as missing.



measure.

?

https://www.cdc.gov/safechild/pdf/national_action_plan_for_child_injury_prevention.pdf.)


2. How many nonfatal injury-related ED visits did the primary caregiver report the index child

had during the reporting period?

Number of ED visits assessed –

Include the total number of

reported ED visits in the

numerator.

Information missing/ED assessment not completed –

Include in missing cases for this measure.

?


Measure 9: Child Maltreatment




CONSTRUCT: Child Maltreatment

2. TYPE OF MEASURE

System Outcome


Percent of children enrolled in home visiting with at least 1 investigated case of maltreatment following enrollment within the reporting period

4. SPECIFICATION

NUMERATOR: Number of children (index child) enrolled in home visiting with at least 1 investigated case of maltreatment since enrollment DENOMINATOR: Number of children (index child) enrolled in home visiting


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 9: Details

Target Population: Enrolled index children. Data Collection Time Point: End of reporting period. Frequency of Reporting: This measure is assessed in multiple reporting years for all eligible index children enrolled in the program. Eligible children may therefore be included in more than one annual report. Suggested Data Elements: Investigated child maltreatment, date of investigated child maltreatment. Validated Tool: N/A Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. Missing data should not be included in the measure calculation.


Additional Notes:

Child maltreatment data should only be recorded if they occur during enrollment. Incidences that occurred during the reporting period but prior to enrollment should be excluded.

This measure is reported for each reporting period the child is enrolled. Data reported each reporting period reflect the time enrolled during that reporting period only, not cumulatively across all years enrolled.

Regardless of the disposition or outcome of the investigation, this measure captures children with at least one investigated case of maltreatment. For this measure, investigated cases have an allegation of maltreatment that was screened-in for investigation or assessment and received further investigation. (Reference: U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2017). Child Maltreatment 2015. Available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment.) A screened-in report is one that is accepted for investigation or assessment based on the state screen-in criteria. (Reference: Child Welfare Information Gateway. Screening and Intake. Retrieved from https://www.childwelfare.gov/topics/responding/iia/screening/.)

Retrospective data collection and matching are acceptable for this measure if child welfare data is not available during the reporting period.



Measure Definition: Percentage of index children enrolled in home visiting with at least one investigated case of maltreatment following enrollment and occurring within the reporting period. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the index child was enrolled in home visiting during the reporting period and (2) if child maltreatment data on investigated case of maltreatment was collected from the child welfare agency during the reporting period. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:


reporting period?


question.




counted as missing.



measure.

?

http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment

http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment

https://www.childwelfare.gov/topics/responding/iia/screening/


2. As reported by the child welfare agency, has the index child had at least one investigated case

of maltreatment since enrollment?






numerator.



measure.

? / /


Measure 10: Parent-Child Interaction



1. BENCHMARK AREA: SCHOOL READINESS AND ACHIEVEMENT

CONSTRUCT: Parent-Child Interaction

2. TYPE OF MEASURE



Percent of primary caregivers enrolled in home visiting who receive an observation of caregiver-child interactions by the home visitor using a validated tool

4. SPECIFICATION

NUMERATOR: Number of primary caregivers enrolled in home visiting who receive an observation of caregiver-child interactions by the home visitor using a validated tool DENOMINATOR: Number of primary caregivers enrolled in home visiting with children reaching the target age range


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 10: Details

Target Population: Primary caregivers with index children within the target age range of the validated tool selected. Data Collection Time Point: Based on the administration protocol specified by the validated tool selected and the child’s age during the reporting period. Frequency of Reporting: This measure may be assessed at multiple points in time per eligible primary caregiver and will be determined by the administration protocol of the tool selected. Eligible participants may therefore be included in more than one annual report. Only one observation per primary caregiver should be reported. Awardees should report using the most recent caregiver-child interaction assessment by the end of the reporting period. Suggested Data Elements: Parent-child interaction observation, parent-child interaction observation date. Validated Tool: Awardees must use a validated tool for this measure. Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. When there is no documentation of whether the primary


caregiver received an observation of caregiver-child interaction by the home visitor using a validated tool, but all other data elements are known, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator. Additional Notes:

All primary caregivers with children within the entire target age range of the selected tool should be reported.

Only one observation per primary caregiver (not for each primary caregiver-child dyad) should be reported.

Although this measure may be assessed at multiple time points, the recommended age interval closest to the end of the reporting period is the assessment that should be reported.



Measure Definition: Percent of primary caregivers enrolled in home visiting who receive an observation of caregiver-child interactions by the home visitor using a validated tool. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if each primary caregiver enrolled in your program had an index child who reached the valid age range of the parent-child interaction tool during the reporting period (2) if the primary caregiver received a caregiver-child interaction by the home visitor using a validated tool during the reporting period. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each primary caregiver enrolled in your program, did any have an index child who reached

the valid age range required by the parent-child interaction tool during the reporting period?


question.




counted as missing.



measure if the index child’s age

cannot be determined or is

missing

2. For each primary caregiver enrolled in your program, did s/he receive a caregiver-child

interaction by the home visitor using a validated tool during the reporting period?






numerator.


in denominator for this

measure, but do not include in

numerator.

?

/ / /


Measure 11: Early Language and Literacy Activities




CONSTRUCT: Early Language and Literacy Activities

2. TYPE OF MEASURE



Percent of children enrolled in home visiting with a family member who reported that during a typical week s/he read, told stories, and/or sang songs with their child daily, every day

4. SPECIFICATION

NUMERATOR: Number of children (index child) enrolled in home visiting with a family member who reported that during a typical week s/he read, told stories, and/or sang songs with their child daily, every day DENOMINATOR: Number of children (index child) enrolled in home visiting


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 11: Details

Target Population: Enrolled index children. Data Collection Time Point: End of reporting period. Frequency of Reporting: This measure is assessed in multiple reporting years for all eligible index children enrolled in the program. Eligible children may therefore be included in more than one annual report. Suggested Data Elements: Caregiver or family member support of early language and literacy activities, date of caregiver or family member support of early language and literacy activities. Validated Tool: N/A Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. Missing data should not be included in the measure calculation. Additional Notes:

To accurately assess this measure, caregivers or family members should be asked if they (1) read, (2) told stories, and/or (3) sang songs to their children every day during a typical week.


The measure asks primary caregivers or other family members to reflect on a typical week and report if at least one of the activities occurred each day during the week. Any combination of these activities over the week meets the criteria.

Support of early language and literacy activities may be provided by a primary caregiver or other family members and does not need to be the same person each day.

Although this measure may be collected at multiple data collection intervals, the data collection time point closest to the end of the reporting period should be used for reporting on the measure.



Measure Definition: Percentage of index children enrolled in home visiting with a caregiver or family member who reported that during a typical week s/he read, told stories, and/or sang songs with her/his child daily, every day Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the index child was enrolled in home visiting for any length of time during the reporting period and (2) if the caregiver or family member was assessed for engaging in early language and literacy activities with the child. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:


reporting period?


question.




counted as missing.



measure.

2. Did the caregiver or family member report that during a typical week s/he read, told stories,

and/or sang songs with her/his index child daily, every day?






numerator.



measure.

?

? / /


Measure 12: Developmental Screening




CONSTRUCT: Developmental Screening

2. TYPE OF MEASURE



Percent of children enrolled in home visiting with a timely screen for developmental delays using a validated parent-completed tool

4. SPECIFICATION

NUMERATOR: Number of children (index child) enrolled in home visiting with at least one screening within the AAP-defined age groups during the reporting period DENOMINATOR: Number of children (index child) enrolled in home visiting reaching the specified time frame during the reporting period


Value: (percentage)

Numerator:

Denominator:

6. NOTES




Measure 12: Details

Target Population: Primary caregivers with index children aged 9 months to 30 months. Data Collection Time Point: Throughout reporting period for children aged 9 months to 30 months. Frequency of Reporting: This measure is assessed in multiple reporting years for all eligible index children enrolled in the program. Eligible children may therefore be included in more than one annual report. Suggested Data Elements: Date of developmental screening, index child age (eligibility for assessment). Validated Tool: Awardees must use a validated tool that follows the AAP-recommended age intervals to determine when a developmental screening is expected for a given child. Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are


unknown, data are considered missing. When there is no documentation of whether the screening for developmental delays occurred using a validated tool, but all other data elements are known, then the child should be included in the denominator (if eligible), but not in the numerator. Additional Notes:

Developmental delays include delays in any or all areas including cognitive, social, language, sensory, and emotional development. (Reference: U.S. National Library of Medicine, National Institutes of Health. Psychological Index Terms via Unified Medical Language System, 2015. Retrieved from http://ghr.nlm.nih.gov/glossary=developmentaldelay.)

Awardees should screen index children for developmental delays at each AAP-recommended age interval. AAP recommends that, at a minimum, standardized developmental screening tools should be administered when the child is 9-months, 18-months, and 24- or 30-months of age.

Awardees should refer to the screening window provided by the tool developer. For instance, a tool may require the 9-month screener to be administered between 9 months 0 days and 9 months 30 days.

AAP guidelines can be found on http://pediatrics.aappublications.org/content/118/1/405.full.

A child may be excluded from the denominator if s/he has a previously identified developmental delay (prior to enrollment or prior to reaching an age-recommended screening).



Measure Definition: Percentage of index children enrolled in home visiting with a timely screen for developmental delays using a validated parent-completed tool. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the index child is between the ages of 9 months and 30 months during the reporting period and (2) if the index child was screened for developmental delays with a validated tool during one of the AAP-defined age groups (9-months, 18-months, and 24- or 30-months) during the reporting period. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each index child enrolled in your program, was s/he between 9 and 30 months of age?


question.

No – The index child is not



counted as missing.



measure.

?

http://ghr.nlm.nih.gov/glossary=developmentaldelay

http://pediatrics.aappublications.org/content/118/1/405.full


2. Was the index child screened for developmental delays with a validated tool during the

reporting period?

Yes – Include in the numerator

and denominator for this

measure.

No – Continue to the next

question.



for this measure but not the

numerator.

3. If the index child was not screened for developmental delays during the reporting period, did

s/he have a previous positive screen in a prior reporting period or before being enrolled?

Yes – Exclude from the

measure.



but not the numerator.


in the denominator for this

measure but not the

numerator.

/

/ /

/


Measure 13: Behavioral Concerns




CONSTRUCT: Behavioral Concerns

2. TYPE OF MEASURE



Percent of home visits where primary caregivers were asked if they have any concerns regarding their child’s development, behavior, or learning

4. SPECIFICATION

NUMERATOR: Number of home visits where primary caregivers enrolled in home visiting were asked if they have any concerns regarding their child’s development, behavior, or learning DENOMINATOR: Total number of home visits during the reporting period


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 13: Details

Target Population: Postnatal primary caregivers with index children. Data Collection Time Point: Each home visit throughout the reporting period. Frequency of Reporting: This measure is assessed in multiple reporting years per eligible family. Eligible families may therefore be included in more than one annual report. It will only be assessed once per family per visit, regardless of the number of index children enrolled. Suggested Data Elements: Developmental concerns inquiry, home visit date, primary caregiver’s pre- or postnatal status. Validated Tool: N/A Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. If a home visit occurred, but there is no documentation of whether the primary caregiver was asked about behavioral concerns, then the home visit should be included in the denominator (if eligible), but not in the numerator. Home visits should not be counted for prenatal primary caregivers prior to delivery of the index child.


Additional Notes:

This measure requires home visitors to document if they did or did not ask the primary caregiver about developmental, behavioral, or learning concerns during each home visit that occurs postnatally.

This measure captures the proportion of home visits where behavior concerns were discussed during all home visits in the reporting period.



Measure Definition: Percentage of home visits where primary caregivers were asked if they have any concerns regarding their index children’s development, behavior, or learning. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the primary caregiver was postnatal for any length of time during the reporting period, (2) how many home visits occurred during the reporting period in which the primary caregiver was postnatal, and (3) how many home visits the primary caregiver was asked about behavioral concerns with the index child. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. Was the primary caregiver postnatal for any length of time during the reporting period?


question.

No – This primary caregiver’s

home visits are not included in

the numerator or denominator

and is not counted as missing.



measure.

2. How many home visits occurred during the reporting period in which the primary caregiver

was postnatal?


home visits that met this

criterion in the denominator.

?


3. How many home visits occurred in the reporting period in which the primary caregiver was

asked if she had any concerns regarding her index child’s development, behavior, or learning?


home visits that met this

criterion in the numerator.


Measure 14: Intimate Partner Violence Screening




CONSTRUCT: Intimate Partner Violence Screening

2. TYPE OF MEASURE



Percent of primary caregivers enrolled in home visiting who are screened for intimate partner violence (IPV) using a validated tool

4. SPECIFICATION

NUMERATOR: Number of primary caregivers enrolled in home visiting who are screened for IPV using a validated tool within 6 months of enrollment DENOMINATOR: Number of primary caregivers enrolled in home visiting for at least 6 months


Value: (percentage)

Numerator:

Denominator:

6. NOTES




Measure 14: Details

Target Population: Primary caregivers enrolled for at least 6 months. Data Collection Time Point: 6 months post-enrollment. Frequency of Reporting: This measure is assessed at one point in time per eligible family. Suggested Data Elements: IPV screening, IPV screening date, date of enrollment. Validated Tool: Awardees must use a validated tool for this measure. A list of commonly used IPV screeners can be found in Appendix B. Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. When there is no documentation of whether the screening for IPV occurred using a validated tool (including if the screening did not occur because the caregiver was male and there are only validated tools for use among female caregivers), but all other data elements


are known, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator. Additional Notes:

IPV refers to physical violence, sexual violence, stalking, and psychological aggression (including coercive acts) by a current or former intimate partner. An intimate partner is a person with whom one has a close personal relationship that can be characterized by the following: emotional connectedness, regular contact, ongoing physical contact and sexual behavior, identity as a couple, and familiarity and knowledge about each other’s lives. (Reference: Centers for Disease Control and Prevention. Injury Prevention and Control: Division of Violence Prevention, 2015. Retrieved from http://www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html.)

All primary caregivers should be screened for IPV regardless of relationship status.

Awardees will need to ensure home visitors receive adequate training in the administration of the selected IPV screening tool.



Measure Definition: Percentage of primary caregivers enrolled in home visiting who are screened for IPV using a validated tool. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the primary caregiver reached 6 months post enrollment during the reporting period and (2) if the primary caregiver was screened for IPV on or before 6 months post enrollment. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each primary caregiver enrolled in your program, did s/he reach 6 months post enrollment



question.




counted as missing.



measure

?

http://www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html


2. Did the primary caregiver receive an IPV screening using a validated tool within 6 months of

enrollment?






numerator.



for this measure, but do not

include in the numerator.

/ / /


Measure 15: Primary Caregiver Education



1. BENCHMARK AREA: FAMILY ECONOMIC SELF-SUFFICIENCY

CONSTRUCT: Primary Caregiver Education

2. TYPE OF MEASURE

Systems Outcome


Percent of primary caregivers who enrolled in home visiting without a high school degree or equivalent who subsequently enrolled in, maintained continuous enrollment in, or completed high school or equivalent during their participation in home visiting

4. SPECIFICATION

NUMERATOR: Number of primary caregivers who enrolled in, maintained continuous enrollment in, or completed a high school degree or equivalent after enrollment in home visiting (and met the conditions specified in the denominator) DENOMINATOR: Number of primary caregivers without a high school degree or equivalent at enrollment


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 15: Details

Target Population: Primary caregivers without a high school diploma or equivalent at enrollment. Data Collection Time Point: Enrollment and end of each reporting period. Frequency of Reporting: This measure may be assessed in multiple reporting years per eligible family. Primary caregivers who are eligible to be included in the denominator will be included in each annual report until the conditions in the numerator have been met. This means that a family may be included in more than one annual report. However, once the condition in the numerator is met, the primary caregiver will not be assessed in subsequent reporting periods. Primary caregivers who did not have a high school degree or equivalent at enrollment will be assessed for this measure during each reporting period for which they are enrolled. Suggested Data Elements: High school diploma or equivalent status at enrollment, enrollment or completion of high school diploma or equivalent, enrollment of completion of high school diploma or equivalent screening date.


Validated Tool: N/A Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. Missing data should not be included in the measure calculation. Additional Notes: To be counted in the numerator, one of three conditions must be met for the primary caregiver: (1) s/he did not have a high school diploma or equivalent at enrollment but enrolled in an educational program aimed at attaining a high school diploma or equivalent during the reporting period; (2) s/he did not have a high school diploma or equivalent at enrollment, but was enrolled in and maintained enrollment in an educational program aimed at attaining a high school diploma or equivalent during the reporting period; or (3) s/he did not have a high school diploma or equivalent at enrollment but completed an educational program aimed at attaining a high school diploma or equivalent during the reporting period.



Measure Definition: Percentage of primary caregivers who enrolled in home visiting without a high school diploma or equivalent who subsequently enrolled and maintained continuous enrollment in a high school program or completed a diploma or equivalent during their participation in home visiting. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the primary caregiver was assessed for having a high school diploma or equivalent at the time of enrollment and (2) what is the educational status of primary caregiver at or near the end of the reporting period. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each primary caregiver enrolled in your program, did s/he report not having a high school

diploma or equivalent at the time of enrollment?

Yes – Continue to

next question.




counted as missing.



measure.

?


2. Did the primary caregiver report being enrolled in or completing a high school diploma or

equivalent at or near the end of the reporting period?






numerator.



measure.

? / /


Measure 16: Continuity of Insurance Coverage



1. BENCHMARK AREA: FAMILY ECONOMIC SELF-SUFFICIENCY

CONSTRUCT: Continuity of Insurance Coverage

2. TYPE OF MEASURE

Systems Outcome


Percent of primary caregivers enrolled in home visiting who had continuous health insurance coverage for at least 6 consecutive months

4. SPECIFICATION

NUMERATOR: Number of primary caregivers enrolled in home visiting who reported having health insurance coverage for at least 6 consecutive months since enrollment in home visiting DENOMINATOR: Number of primary caregivers enrolled in home visiting for at least 6 months


Value: (percentage)

Numerator:

Denominator:

6. NOTES


Measure 16: Details

Target Population: Primary caregivers who have been enrolled in home visiting for 6 consecutive months during the reporting period. Data Collection Time Point: Measured on or after 6 months post-enrollment. Frequency of Reporting: This measure is assessed in multiple reporting years per eligible family. Eligible families may therefore be included in more than one annual report. Suggested Data Elements: Date of enrollment, continuous health insurance status for 6 months. Validated Tool: N/A Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. Missing data should not be included in the measure calculation. Additional Notes:

Continuous health insurance coverage refers to having coverage without any lapses.

Primary caregivers should be assessed for this measure each reporting period (as long as they have been enrolled for at least 6 consecutive months in a given reporting period).


The 6 consecutive months of health insurance coverage must be in the same reporting period and should not overlap another reporting period.

This could be collected by (1) directly asking primary caregivers how many months they have had continuous health insurance coverage each reporting year or by (2) tracking health insurance status for each month to compute whether insurance was maintained for at least 6 consecutive months.



Measure Definition: Percentage of primary caregivers enrolled in home visiting who had continuous health insurance coverage for at least 6 consecutive months during the reporting period. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the primary caregiver has been enrolled in the program for 6 or more months during the reporting period and (2) if s/he reported having health insurance coverage for at least 6 consecutive months. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each primary caregiver enrolled in your program, was s/he enrolled in the program for at

least 6 months during the reporting period?

Yes – Continue to

next question.




counted as missing.



measure.

2. During the reporting period, did the primary caregiver report having health insurance

coverage for 6 consecutive months?






numerator.

Information missing – Do not

include in the numerator or

denominator.

?

? / /


Measure 17: Completed Depression Referrals



1. BENCHMARK AREA: COORDINATION AND REFERRALS FOR OTHER COMMUNITY RESOURCES AND SUPPORTS

CONSTRUCT: Completed Depression Referrals

2. TYPE OF MEASURE

Systems Outcome


Percent of primary caregivers referred to services for a positive screen for depression who receive one or more service contacts

4. SPECIFICATION

NUMERATOR: Number of primary caregivers enrolled in home visiting who received recommended services for depression (and met the conditions specified in the denominator) DENOMINATOR: Number of primary caregivers enrolled in home visiting who had a positive screen for depression within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for those enrolled prenatally) and were referred for services


Value: (percentage)

Numerator:

Denominator:

6. NOTES




Measure 17: Details

Target Population: Primary caregivers who screened positive for depressive symptoms and were referred for services. Data Collection Time Point: After referral for positive depression screening. Frequency of Reporting: This measure may be assessed in multiple reporting years per eligible family. Primary caregivers who are eligible to be included in the denominator will be included in each annual report until the conditions in the numerator have been met. This means that a family may be included in more than one annual report. Primary caregivers do not need to be reported again for subsequent pregnancies that occur after they are enrolled in home visiting. To assess this measure accurately, participants need to be screened for depressive symptoms at the appropriate time points (as specified in Measure 3: Depression Screening), receive a referral for a positive screening, and be monitored for


receipt of services from the referral agency. Since there is no specified time frame for when the receipt of services needs to be completed, the receipt of services may occur in a different reporting period than the screening and/or time of referral. As such, the numerator and denominator do not need to include the same sample as Measure 3 since the receipt of services can take place in a different reporting period than the depression screening. Suggested Data Elements: Prenatal status, child date of birth, date of enrollment, positive depression screening results, referral for depression services, depression services received date. Validated Tool: The validated depression screening tool used for Measure 3: Depression Screening should be indicated when reporting this measure. Missing Data: Missing data will affect the accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. When there is no documentation of whether a referral was provided, but all other data elements are known, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator. Additional Notes:

After a positive depression screening, this measure tracks participant receipt of services from a referral agency.

Recommended referral services refer to specific techniques and intervention models delivered in the context of client characteristics, culture, and preferences that have shown to have positive effects on outcomes through rigorous evaluations and have demonstrated to achieve positive outcomes for the client. (Reference: Home Visiting Collaborative Improvement and Innovation Network.)

If a data sharing agreement has been established, receipt of services may be assessed through participant self-report or by following up with the referral agency.



Measure Definition: Percentage of primary caregivers referred to services for a positive screening for depression who have received one or more service contacts. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify (1) if the primary caregiver screened positive for depressive symptoms with a validated tool within 3 months of enrollment (for those enrolled postnatally) or within 3 months postpartum (for those enrolled prenatally) and (2) if the primary caregiver was referred for services. Logic Statements: The following steps will help to identify whom to count in the measure and how to identify missing data:

1. For each primary caregiver enrolled in your program, did she screen positive for depressive

symptoms within 3 months of enrollment (for those not enrolled prenatally) or within 3

months of delivery (for those enrolled prenatally)?



question.




counted as missing.



measure.

2. Did the primary caregiver receive a referral for the positive screening?

Yes – Continue to

next question.

No, but reason unknown – The

primary caregiver is included in the

denominator but not the numerator.

No, because the

primary caregiver is

already receiving

services for depressive

symptoms – The

primary caregiver is

not included in the

numerator or

denominator and is

not counted as

missing.

Information missing – The primary caregiver

is included in the denominator but not

the numerator.

3. Did the primary caregivers receive recommended services for depressive symptoms?



No – Included in the



numerator.

Information missing – Include in the denominator for this

measure, but not the numerator.

?

/

/

/

/ /


Measure 18: Completed Developmental Referrals




CONSTRUCT: Completed Developmental Referrals

2. TYPE OF MEASURE

Systems Outcome


Percent of children enrolled in home visiting with positive screens for developmental delays (measured using a validated tool) who receive services in a timely manner

4. SPECIFICATION

NUMERATOR: Number of children enrolled in home visiting who a) received individualized developmental support from a home visitor; b) were referred to early intervention services and received an evaluation within 45 days; OR c) were referred to other community services who received services within 30 days (and met the conditions specified in the denominator) DENOMINATOR: Number of children enrolled in home visiting with positive screens for developmental delays (measured using a validated tool)


Value: (percentage)

Numerator:

Denominator:

6. NOTES

7. Measurement Tool Utilized



Measure 18: Details

Target Population: Index children who screened positive for developmental delays. Data Collection Time Point: After positive developmental screening. Frequency of Reporting: This measure may be assessed in multiple reporting years for all index children enrolled in the program. Children who are eligible to be included in the denominator will be included in each annual report until the conditions in the numerator have been met. This means that index children may be included in more than one annual report. While this measure is related to Measure 12, this measure tracks the receipt of services in a given reporting period rather than screenings that occurred in that period. Since the referral services can take place as much as a month to 45 days after the screening, it is possible that the receipt of developmental services would fall into the following reporting period. As


such, the numerator and denominator do not need to include the same sample as Measure 12 since the developmental screening can take place in a previous reporting period from the receipt of services. Suggested Data Elements: Positive developmental screening, developmental delay services received, developmental delay service date. Validated Tool: Validated developmental screening tool used for Measure 12: Developmental Screening should be indicated when reporting this measure. Missing Data: Missing data will affect accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. When there is no documentation of whether the screening for developmental delays occurred using a validated tool, but all other data elements are available, then the index child should be included in the denominator (if eligible), but not in the numerator. Additional Notes:

Developmental delays may include delays in any or all areas including cognitive, social, language, sensory, and emotional development. (Reference: U.S. National Library of Medicine, National Institutes of Health. Psychological Index Terms via Unified Medical Language System, 2015. Retrieved from http://ghr.nlm.nih.gov/glossary=developmentaldelay.)

This measure tracks participant receipt of services after a positive developmental screening. To assess this measure accurately, index children who positively screen for a developmental delay should be monitored for services received within the specified time.

If a data sharing agreement has been established with the referral agency, receipt of services may be assessed through participant self-report or by following up with the referral agency.

Positive screenings from any developmental screening can be included in this measure, not just those that align with AAP-recommended screening time points.

A child may be excluded from the denominator if s/he has a previously identified developmental delay (prior to enrollment or prior to reaching an age-recommended screening).

Each of the three individual conditions described below can satisfy the numerator. The home visitor may be required to have a developmental screening followup process that involves tracking the services the primary caregiver and/or index child received and the dates associated with the followup. To be counted in the numerator, the index child must meet one of three conditions.

(1) Received individualized developmental support from a home visitor. This is a home visitor-delivered, specific developmental promotion to address the area of concern. This can include more frequent screenings, activities by model curriculum, ASQ activities, and CDC materials to target the developmental skill or domain for which there was a concern or positive screen. (2) Received a referral to early intervention services and received an evaluation or individualized service plan within 45 days of that referral. This refers to index children with developmental and behavioral concerns that meet the criteria for referral to Part B or Part C early intervention services. The criteria for referral to Part B and Part C early intervention services vary by state and locale. Each program needs to be aware of what local criteria are for referring children. (3) Received a referral to another community service and received services from that provider within 30 days. This includes any services available that provide developmentally-enhancing support to children and families that do not fall under the funding/ reimbursement system for Part B or Part C early intervention services. Examples include drop-in centers, parent-child groups, early literacy supports, and parent training. This may also include early childhood mental health treatment.

http://ghr.nlm.nih.gov/glossary=developmentaldelay




Measure Definition: Percentage of index children enrolled in home visiting with positive screens for developmental delays (measured using a validated tool) who received services in a timely manner. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify if the index child was screened positive during the reporting period for developmental delays with a validated tool. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

1. For each index child enrolled in your program who was screened for developmental delays, did

s/he screen positive?

Yes – Continue to

next question. No – This index child is not



counted as missing.



measure.

2. For each index child enrolled in your program who screened positive for developmental delays,

were one of the following criteria met: a) received individualized developmental support from

a home visitor, b) referred to early intervention services and received an evaluation within 45

days, OR c) referred to other community services who received services within 30 days?

Yes – Include in

numerator and

denominator for this

measure.

No, because the index child was already

receiving services or had a previously

identified developmental delay

(prior to enrollment or prior to the due date

for an age recommended

screening) – This child is not included in the

numerator or denominator and is

not counted as missing.

No, for other reason –

Include in


measure, but do not


Information missing –

Include in


measure, but do not


?

/ / /


Measure 19: Intimate Partner Violence Referrals




CONSTRUCT: Intimate Partner Violence Referrals

2. TYPE OF MEASURE



Percent of primary caregivers enrolled in home visiting with positive screens for IPV (measured using a validated tool) who receive referral information to IPV resources

4. SPECIFICATION

NUMERATOR: Number of primary caregivers enrolled in home visiting who received referral information to IPV resources (and met the conditions specified in the denominator) DENOMINATOR: Number of primary caregivers enrolled in home visiting with positive screens for IPV (measured using a validated tool) within 6 months of enrollment


Value: (percentage)

Numerator:

Denominator:

6. NOTES

7. Measurement Tool Utilized



Measure 19: Details

Target Population: Primary caregivers who screened positive for intimate partner violence (IPV). Data Collection Time Point: After positive IPV screening. Frequency of Reporting: This measure may be assessed in multiple reporting years per eligible family. Primary caregivers who are eligible to be included in the denominator will be included in each annual report until the conditions in the numerator have been met. This means that a family may be included in more than one annual report. This measure does not track receipt of referral services, only referrals made for positive IPV screenings. Although IPV screenings must occur within 6 months of enrollment, there is no specific time frame for when the referral should occur. The referral can occur in a different reporting period than the screening. As such, the numerator and denominator do not need to include the same sample as Measure 14 since


the IPV screening can take place in a previous reporting period from the receipt of services. Suggested Data Elements: Positive IPV screening results, IPV screening date, IPV referral, IPV referral date, date of enrollment. Validated Tool: Validated IPV screening tool used for Measure 14: IPV Screening should be indicated when reporting this measure. Missing Data: Missing data will affect the accuracy of data and should be reported in the notes section. If one or more data elements needed to determine inclusion in the numerator or denominator are unknown, data are considered missing. When there is no documentation of whether the screening for IPV occurred using a validated tool, but all other data elements are available, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator. Additional Notes:

IPV refers to physical violence, sexual violence, stalking and psychological aggression (including coercive acts) by a current or former intimate partner. An intimate partner is a person with whom one has a close personal relationship characterized by the following: emotional connectedness, regular contact, ongoing physical contact and sexual behavior, identity as a couple, and familiarity and knowledge about each other’s lives. (Reference: Centers for Disease Control and Prevention. Injury Prevention and Control: Division of Violence Prevention, 2015. Retrieved from http://www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html.)

All primary caregivers should be screened for IPV regardless of relationship status.

Awardees will need to ensure home visitors receive adequate training in the administration of the selected IPV screening tool.



Measure Definition: Percentage of primary caregivers enrolled in home visiting with positive screens for IPV (measured using a validated tool) who receive referral information to IPV resources. Inclusion Criteria: To determine if participant data should be included in the measure calculation, at the end of the reporting period verify if the primary caregiver screened positive for IPV using a validated tool within the first 6 months of enrollment. Logic Statements: The following steps will help to identify whom to include in the measure and how to identify missing data:

http://www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html


1. For each primary caregiver enrolled in your program, did s/he screen positive for IPV using a

validated tool within the first 6 months of enrollment?

Yes – Continue to

next question.




counted as missing.



measure.

2. Did the primary caregiver receive a referral for IPV resources during the reporting period?






numerator.

Referral status missing –

Include in the denominator for

this measure, but do not

include in the numerator.

?

/ / /


Appendix A

Guidance on Reporting Index Children

Due to several questions received from awardees, HRSA would like to clarify guidance related to the reporting of index children for the purposes of FY 2017 annual performance reporting. Guidance for reporting index children on Form 1 remains the same as in previous years. As such, all children who meet the definition of an index child who were enrolled in home visiting services during the reporting period should be reported on Form 1. For the purposes of Form 2, the same standard used for Form 1 will apply. All children who meet the definition of an index child, were enrolled in home visiting services during the reporting period, and meet the inclusion criteria for a given measure should be reported in the appropriate measures contained in Form 2. HRSA acknowledges that this is a change in guidance from previous reporting periods. Due to the potential extent of this change for some awardees, DHVECS is issuing the following guidance: Awardees must report all index children enrolled in the program, including subsequent pregnancies after enrollment, on Form 2. However, awardees who are unable to meet this requirement for the FY 2017 reporting period (10/1/2016-9/30/2017) may begin implementing this standard for the FY 2018 reporting period (10/1/2017-9/30/2018). This phased-in approach applies only to Form 2. Awardees should indicate in their Performance Measurement Plans how they will report index children on Form 2. All awardees are expected to report all enrollees, including all index children, on Form 1. Please note that the definition of an index child has been updated to further clarify that multiple index children per family may be enrolled. Awardees should follow programmatic and model-specific guidance related to the enrollment and reporting of multiple index children per household. Guidance related to the identification and reporting of primary caregivers is not impacted by this guidance. The table on the following page provides clarification on how to report on measures which reference the primary caregiver and index child. Additional clarification is provided below the table for selected measures.


In the table below, the first column lists measures where the unit of measurement is the index child, and the guidance for these measures is to report on all index children, including those from subsequent pregnancies. In the last column, the unit of measurement is the caregiver without reference to the index child. These measures are not impacted by the additional clarification for reporting index children. For the measures listed in the second column, the unit of measurement is the primary caregiver, but the measure references the index child. For some of these measures, the primary caregiver could be counted more than once in the same or subsequent reporting years, depending on the number of index children enrolled. Further HRSA guidance on these measures is provided below the table.

*Births are the target population, including index children and subsequent children

Below is additional clarification for selected measures.

Column 1: Measures with Index Child as Target Population

Measures 2, 4, 7, 8, 9, 11, 12, 18. These measures need to be reported for all index children,

including those from subsequent pregnancies after enrollment in the home visiting program.

Measure 1: Preterm Birth: This should be reported for each live birth, including those from

subsequent pregnancies after enrollment in the home visiting program.

Column 2: Measures with Primary Caregiver as Target Population with a reference to Child

Measure 3: Depression Screening: This is a one-time measure. Depression screenings do not

need to be reported again for primary caregivers with pregnancies that occur after enrollment in

the home visiting program.

Measure 5: Postpartum Care: This is a one-time measure. Postpartum care does not need to be

reported again for mothers with subsequent pregnancies that occur after enrollment in the

home visiting program.

Measures with Index Child as Target Population

Measures with Primary Caregiver as Target Population with a reference to Index Child

Measures with Primary Caregiver as Target Population

Preterm birth (#1)* Breastfeeding (#2) Well-child visits (#4) Safe sleep (#7) Child injury (#8) Child maltreatment (#9) Early language and literacy activities (#11) Developmental screening (#12) Completed developmental referrals (#18)

Depression screening (#3) Postpartum care (#5) Parent-child interaction (#10) Completed depression referrals (#17)

Tobacco cessation referrals (#6) Behavioral concerns (#13) IPV screening (#14) Education (#15) Health Insurance (#16) IPV referrals (#19)


Measure 10: Parent-Child Interaction: This measure is for the primary caregiver-index child

dyad. It needs to be reported for each dyad that meets the definition of these participants,

including index children from subsequent pregnancies.

Measure 17: Completed Depression Referrals: This is a one-time measure. Completed

depression referrals do not need to be reported again for primary caregivers with subsequent

pregnancies that occur after enrollment in the home visiting program.

Column 3: Measures with Primary Caregiver as Target Population

Measures 6, 13, 14, 15, 16, 19. These measures are not affected by the additional clarification

for reporting index children.


Appendix B

Guidance on Identifying Missing Data

The Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) revised the Home Visiting Program

performance measurement system, which was approved by the Office of Management and Budget (OMB) in March 2016. This guidance includes

instructions for the identification of missing data and is one of several technical assistance resources to support Federal Home Visiting Program

awardees in adopting and implementing the new performance measures.

Construct/Topic Indicator Numerator Denominator Missing Data

1 Preterm Birth

(Systems Outcome) Percent of infants (among mothers who enrolled in home visiting prenatally before 37 weeks) who are born preterm following program enrollment

Number of live births (index child or subsequent children among mothers who enrolled in home visiting prenatally before 37 weeks) born before 37 completed weeks of gestation and after enrollment

Number of live births after enrollment who were born to mothers enrolled in home visiting prenatally before 37 weeks

Data are considered missing if one or more data elements needed to determine inclusion in the numerator or denominator are unknown.

2 Breastfeeding

(Systems Outcome) Percent of infants (among mothers who enrolled in home visiting prenatally) who were breastfed any amount at 6 months of age

Number of infants aged 6-12 months (index child among mothers who enrolled in home visiting prenatally) who were breastfed any amount at 6 months of age

Number of infants aged 6-12 months (index child among mothers who enrolled in home visiting prenatally) enrolled in home visiting for at least 6 months


3 Depression Screening

Percent of primary caregivers enrolled in home visiting who are screened for depression using a validated tool within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for those enrolled prenatally)

For those not enrolled prenatally, number of primary caregivers enrolled in home visiting who are screened for depression within the first 3 months since enrollment; for those enrolled prenatally, the number of primary caregivers screened for depression within 3 months of delivery

For those not enrolled prenatally, the number of primary caregivers enrolled in home visiting for at least 3 months; for those enrolled prenatally, the number of primary caregivers enrolled in home visiting for at least three months post delivery

Data are considered missing if one or more data elements needed to determine inclusion in the numerator or denominator are unknown. When there is no documentation of whether the screening occurred using a validated tool, but all other data elements are known, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator.

4 Well Child Visit Percent of children enrolled in home visiting who received the last recommended visit based on

Number of children (index child) enrolled in home visiting who received the last recommended

Number of children (index child) enrolled in home visiting

Data are considered missing if one or more data elements needed to determine inclusion in the



the American Academy of Pediatrics (AAP) schedule

well child visit based on the AAP schedule

numerator or denominator are unknown, including if the home visit occurred but the home visitor did not collect the data. If a home visit did not occur around the most recent age requiring a well-child visit, then data from the previous expected well-child visit should be reported.

5 Postpartum

Care

Percent of mothers enrolled in home visiting prenatally or within 30 days after delivery who received a postpartum visit with a healthcare provider within 8 weeks (56 days) of delivery

Number of mothers enrolled in home visiting prenatally or within 30 days after delivery who received a postpartum visit with a healthcare provider within 8 weeks (56 days) of delivery

Number of mothers who enrolled in home visiting prenatally or within 30 days after delivery and remained enrolled for at least 8 weeks (56 days) after delivery


6 Tobacco

Cessation Referrals

Percent of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment.

Number of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment

Number of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at enrollment and were enrolled for at least 3 months

Data are considered missing if one or more data elements needed to determine inclusion in the numerator or denominator are unknown, including if there is no documentation of whether the primary caregiver used tobacco or cigarettes at enrollment since inclusion in the denominator cannot be determined if the screening result is unknown. When there is no documentation of whether a referral was provided, but all other data elements are known and inclusion in the denominator can be determined, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator.

7 Safe Sleep

Percent of infants enrolled in home visiting that are always placed to sleep on their backs, without bed-sharing or soft bedding

Number of infants (index child aged less than 1 year) enrolled in home visiting whose primary caregiver reports that they are always placed to sleep on their

Number of infants (index child) enrolled in home visiting who were aged less than 1 year during the reporting period




backs, without bed-sharing or soft bedding

8 Child Injury

(Systems Outcome) Rate of injury-related visits to the Emergency Department (ED) since enrollment among children enrolled in home visiting

Number of parent-reported nonfatal injury-related visits to the ED since enrollment among children (index child) enrolled in home visiting



9 Child

Maltreatment

(Systems Outcome) Percent of children enrolled in home visiting with at least 1 investigated case of maltreatment following enrollment within the reporting period

Number of children (index child) enrolled in home visiting with at least 1 investigated case of maltreatment since enrollment



10 Parent-Child Interaction

Percent of primary caregivers enrolled in home visiting who receive an observation of caregiver-child interaction by the home visitor using a validated tool

Number of primary caregivers enrolled in home visiting who receive an observation of caregiver-child interaction by the home visitor using a validated tool

Number of primary caregivers enrolled in home visiting with children reaching the target age range

Data are considered missing if one or more data elements needed to determine inclusion in the numerator or denominator are unknown. When there is no documentation of whether the primary caregiver received an observation of caregiver-child interaction by the home visitor using a validated tool, but all other data elements are known, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator.

11 Early Language

and Literacy Activities

Percent of children enrolled in home visiting with a family member who reported that during a typical week s/he read, told stories, and/or sang songs with their child daily, every day

Number of children (index child) enrolled in home visiting with a family member who reported that during a typical week s/he read, told stories, and/or sang songs with their child daily, every day



12 Developmental

Screening

Percent of children enrolled in home visiting with a timely screen for developmental delays using a validated parent-completed tool

Number of children (index child) enrolled in home visiting with at least one screening within the AAP-defined age groups during the reporting period

Number of children (index child) enrolled in home visiting reaching the specified time frame during the reporting period

Data are considered missing if one or more data elements needed to determine inclusion in the numerator or denominator are unknown. When there is no documentation of whether the screening occurred using a validated tool, but all other data



elements are known, then the child should be included in the denominator (if eligible), but not in the numerator.

13 Behavioral Concerns

Percent of home visits where primary caregivers were asked if they have any concerns regarding their child’s development, behavior, or learning

Number of home visits where primary caregivers enrolled in home visiting were asked if they have any concerns regarding their child’s development, behavior, or learning

Total number of home visits during the reporting period

Data are considered missing if one or more data elements needed to determine inclusion in the numerator or denominator are unknown. If a home visit occurred, but there is no documentation of whether the primary caregiver was asked about behavioral concerns, then the home visit should be included in the denominator (if eligible – i.e., postnatal visit), but not in the numerator.

14 IPV Screening

Percent of primary caregivers enrolled in home visiting who are screened for intimate partner violence (IPV) within 6 months of enrollment using a validated tool

Number of primary caregivers enrolled in home visiting who are screened for IPV using a validated tool within 6 months of enrollment

Number of primary caregivers enrolled in home visiting for at least 6 months

Data are considered missing if one or more data elements needed to determine inclusion in the numerator or denominator are unknown. When there is no documentation of whether the screening occurred using a validated tool (including if the screening did not occur because the caregiver was male and they only have validated tools for use among female caregivers), but all other data elements are known, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator.

15 Primary

Caregiver Education

(Systems Outcome) Percent of primary caregivers who enrolled in home visiting without a high school degree or equivalent who subsequently enrolled in, maintained continuous enrollment in, or completed high school or equivalent during their participation in home visiting

Number of primary caregivers who enrolled in, maintained continuous enrollment in, or completed a high school degree or equivalent after enrollment in home visiting (and met the conditions specified in the denominator)

Number of primary caregivers without a high school degree or equivalent at enrollment




16

Continuity of Health

Insurance Coverage

(Systems Outcome) Percent of primary caregivers enrolled in home visiting who had continuous health insurance coverage for at least 6 consecutive months

Number of primary caregivers enrolled in home visiting who reported having health insurance coverage for at least 6 consecutive months since enrollment in home visiting

Number of primary caregivers enrolled in home visiting for at least 6 months


17 Completed Depression Referrals

(Systems Outcome) Percent of primary caregivers referred to services for a positive screen for depression who receive one or more service contacts

Number of primary caregivers enrolled in home visiting who received recommended services for depression (and met the conditions specified in the denominator)

Number of primary caregivers enrolled in home visiting who had a positive screen for depression within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for those enrolled prenatally) and were referred for services

Data are considered missing if one or more data elements needed to determine inclusion in the numerator or denominator are unknown, including if there is no documentation of whether the screening occurred using a validated tool since inclusion in the denominator cannot be determined if the screening result is unknown. When there is no documentation of whether a referral was provided, but all other data elements are available and inclusion in the denominator can be determined, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator.

18 Completed

Developmental Referrals

(Systems Outcome) Percent of children enrolled in home visiting with positive screens for developmental delays (measured using a validated tool) who receive services in a timely manner

Number of children enrolled in home visiting who a) received individualized developmental support from a home visitor; b) were referred to early intervention services and receive an evaluation within 45 days; OR c) were referred to other community services who received services within 30 days (and met the conditions specified in the denominator)

Number of children enrolled in home visiting with positive screens for developmental delays (measured using a validated tool)

Data are considered missing if one or more data elements needed to determine inclusion in the numerator or denominator are unknown, including if there is no documentation of whether the screening occurred using a validated tool since inclusion in the denominator cannot be determined if the screening result is unknown. When there is no documentation of whether a referral was provided, but all other data elements are available and inclusion in the denominator can be determined, then the primary



caregiver should be included in the denominator (if eligible), but not in the numerator.

19 IPV referrals

Percent of primary caregivers enrolled in home visiting with positive screens for IPV (measured using a validated tool) who receive referral information to IPV resources

Number of primary caregivers enrolled in home visiting who received referral information to IPV resources (and met the conditions specified in the denominator)

Number of primary caregivers enrolled in home visiting with positive screens for IPV (measured using a validated tool) within 6 months of enrollment

Data are considered missing if one or more data elements needed to determine inclusion in the numerator or denominator are unknown, including if there is no documentation of whether the screening occurred using a validated tool since inclusion in the denominator cannot be determined if the screening result is unknown. When there is no documentation of whether a referral was provided, but all other data elements are available and inclusion in the denominator can be determined, then the primary caregiver should be included in the denominator (if eligible), but not in the numerator.


Appendix C

Content Area Alignment for the MIECHV Program’s Performance Measures

This table summarizes content area alignment for the MIECHV Program’s performance indicators and system outcome measures with other federal measures, national datasets, and indicators from the PEW Home Visiting Data for Performance Initiative. Although many of the content areas align for selected measures, there may be variations in the definition and operationalization of these measures across the data sources.

HRSA/MCHB Federal

Home Visiting Performance Indicators Other HRSA/MCHB Measures

Other Federal Measures National Datasets Other

Measure # Content Area Title V HV CoIIN IM CoIIN Healthy Start Medicaid HP2020 NSCH NHIS PRAMS Other PEW

1 Preterm Birth X X X X NVSS

2 Breastfeeding X X X X X X NIS X

3 Depression Screening

X X X X

4 Well Child Visit X X X X X

5 Postpartum Care X X X X X X

6 Tobacco Cessation Referrals

X X X

7 Safe Sleep X X X X X X

8 Child Injury X X NHAMCS, NEISS

9 Child Maltreatment

X NCANDS X

10 Parent-Child Interaction

11 Early Language and Literacy Activities

X X X

12 Developmental Screening

X X X X X

13 Behavioral Concerns

X


14 IPV Screening X X

15 Primary Caregiver Education

SIPP X

16 Continuity of Health Insurance Coverage

X

HRSA/MCHB Federal Home Visiting

Performance Indicators Other HRSA/MCHB Measures Other Federal

Measures National Datasets Other Measure

# Content Area Title V HV CoIIN IM CoIIN Healthy Start Medicaid HP2020 NSCH NHIS PRAMS Other PEW

17 Completed Depression Referrals

X X

18 Completed Developmental Referrals

X X X X

19 IPV referrals